Sunday, February 28, 2010

Due to a lack of inspiration, and not seeing patients on a Sunday, I'm rerunning this post from April, 2009. It's from back when I had only a few readers, so some of you may not have seen it the first time.

Dr. Grumpy's Guide to Life, Chapter 1

(As a public service I have written the following, for you to print off and use before your next Pump-It-Up party. For those of you who don't have small children, or simply live in a box, Pump-It-Up is a national chain with indoor giant inflatable bouncers to hold kid's birthday parties at).

Congratulations! You've decided to host your child's party at Pump-It-Up.They and their friends will enjoy it a great deal.

Key things to remember:

1. Going into the giant inflatable bouncing arena to fight your kids with oversized boxing gloves and paddles looks easy. Because of your higher center of gravity, however, you'll quickly find out that you're at a distinct disadvantage. In fact, you will likely get your ass kicked fairly easily by the swarm of 1st graders who will line up for a chance to beat you. Fighting on your knees does not improve the situation, and makes it easier for one of their partners to sneak up and jump on your back.

2. Although adults are welcome to go on all the giant bouncers, they are not adult friendly. In particular, the inflatable obstacle course is a good way to get yourself killed. When a kid claws up the inflatable steps and ladder to both of the slides involved, they have plenty of space to reposition themselves at the top to go down the slide feet first. YOU WON'T, and may find yourself pulling yourself to the top of the ladder, then as you are amazed you made it that far, you'll suddenly pitch forward uncontrollably, going down the slide head first and wrenching your neck at the bottom (which I did). While you're lying there, trying to figure out if you can still move your legs, a friendly teenage attendant will come over to remind you that head-first isn't allowed, and to please not do it again.

The steps in the obstacle course ladders are designed for kids and adult pygmies. You will be lucky to be able to use them as toeholds. Trying to climb them with your feet sideways only helps somewhat.

As you struggle through the obstacle course, you can expect to be passed by several kindergartners, who will wonder why their friend's Dad is so slow.

3. You WILL be injured. At present my neck is still stiff and my left ankle is killing me. I also have multiple bruises from falls and being stepped on, and several knee and elbow scrapes. When you first enter the facility and fill out the forms about how many kids you have with you and how many pizzas and bottles of pop you want, I recommend you give them a card listing your insurance coverage, hospital preference, and blood type.

4. Do not feed yourself or your kids a large meal before going unless you wish to spend some of the bouncer time you paid for watching a friendly teenage attendant clean Taco Bell out of a bouncer.

5. If one of the fun-loving kids traps you inside something by turning off the air compressor, don't panic. Before you asphyxiate from vinyl a friendly teenage attendant will turn it back on again, then lecture you not to do it again.

Enjoy! You just paid a fortune for your injuries!

If you follow these simple precautions, you will likely live to see your child's next birthday party - which will also be held at Pump-it-Up.

For my fellow U.S. citizens who are convinced that only our country wastes money on this stuff, the study was paid for by the Canadian Institutes of Health Research.

This is not meant as a slight to my northern colleagues, but simply to point out that pointless research is a universal human trait. If our prehistoric brethren had journals, I'm sure they'd have studies on how wood held in the air is easier to light on fire than wood being held underwater.

It was thoughtful of you to notify me that this product (all 3 varieties) will no longer be available. How much it cost you to send this letter to every doctor in the U.S. & Canada I have no idea.

In all honesty, I have never, ever, ever, recommended a specific denture adhesive to anyone. In fact, in 12 years of practice, I don't think a patient has ever mentioned their chosen brand of such a product to me. Generally, the study of neurology is pretty far removed from whatever substance people might be using to glue their false teeth to their gums.

My office colleague Dr. Pissy, for whatever reason, hasn't gotten your letter yet. I told him this was likely because he was on your Poligrip consumer, rather than prescriber list. He was not amused.

"Hi, I have an appointment with Dr. Grumpy tomorrow, but I keep my schedule on my cell phone calendar, and I've lost the phone. Can someone please call and tell me what time my appointment is? My cell phone is 867-5309. Thank you."

Tuesday, February 23, 2010

Dr. Grumpy: "How have you been doing since starting the Parkinson's medication?"

Mr. Shakes: "Much better. My wife doesn't yell at me as much about my driving. And since you gave me those pills I haven't blown out any tires from hitting the curb, which is nice. Those replacement tires can get expensive."

For those of you who missed my previous post on drug company gadgetry, click here.

Okay, this awesome doodad was dropped off at my office last month. I took some shots of it when I had time, but didn't get to put them up until now.

This AMAZING doohickey thingamajig is designed to demonstrate how gout happens.

So let's start with the first shot. The yellow slider is on the right, showing a LOW blood level of uric acid. The patient on the left looks comfortable, and the joint shown has a soothing shade of blue.

BUT NOW we slide the yellow switch over to the left, RAISING the blood's uric acid level. The patient's joints now glow red (get it? He's hurting?) and the big joint on the right is now bright red, with sharp, ugly, uric acid crystals causing gout pain.

Isn't it amazing what technology can do these days? And I can't even use it for a fish tank. Look for it at my next garage sale. After I remove the AA batteries to use in my Wiimote.

Monday, February 22, 2010

I'd like to tell the unknown persons who broke in and stole a bunch of my school's band's musical instruments last night that you are complete utter worthless asshole scum.

The school is too poor to buy replacements. Those were bought several years ago on a fundraising drive from the band, and have been carefully kept up since then, at teacher and student's personal expense.

I know that in a world of crappy economy, a horrible earthquake in Haiti, wars, and famine, a few instruments in a school for underprivileged children (many of whom live in shelters) are minor compared to the big picture of human suffering.

Telling me that you were in ER with a bloody nose last night is good enough for me. I trust you.

I SWEAR that it is NOT necessary for you to whip out your iPhone and show me pictures of blood and mucus streaming down your face. Or to show me the tail of the gauze sponge that is still lodged up there.

Okay, at the request of readers who have written in I've put up a few new items. I've been meaning to do this for a while, but yesterday had the time to do so while I was being held hostage at Chuck-E-Cheese (their motto: "Where a kid can be a terrorist").

One is an I HATE CALL!!! t-shirt, to which I've added some artistic culture by including that classic portrait of an on-call physician, The Scream by Edvard Munch.

Friday, February 19, 2010

I can hear children screaming. Adults trying to calm them down.I can smell something burning in the distance.A mass of humanity pushes and pulls aimlessly.Starving people surround me.Police in riot gear should be here, with tear gas and water cannons.But no one comes to help.I tell myself "this can't be America"But it is.I tell myself "this can't be my hometown"But it is.

Drug reps get a bad rap, though I often try to stand up for them. Certainly, some are ill-mannered, but I like most.

And today, I like them, or at least sympathize with them, even more.

As my regular readers know, I have a few side jobs outside of my regular practice. Most involve research and consulting, but occasionally a drug company will ask me to do a speaking gig about their product (if you have a problem with me doing this, sorry).

So yesterday, I got to be a drug rep (sort-of) for one hour. I was asked to accompany a guy named Mike, who's a nice rep, to give a brief talk & answer questions during a lunch he was hosting at Large & Soulless Internal Medicine, P.C.

And guess what I found (as if I didn't already know): A LOT OF OTHER DOCTORS ARE ASSES!

Now, I know that doesn't come as a surprise to many of you (especially the nurses), but I was a bit stunned to see it from a drug rep's view.

During my hour in that office's break room, I encountered 5 physicians. Keep in mind that this was a scheduled event for the physicians' day, NOT a drop-in.

Physician #1:

Dr. Rushed: "HelloI'mDoctorRushedwhatproductdoyouhave?"

Mike: "I carry Limpeter, an FDA approved treatment for Neuropriapism, and this is Dr. Grumpy. He's a neurologist out on the west side, and..."

Dr. Unseen: (loud voice outside breakroom) "It's a rep? I don't want to see a fucking rep! I hate reps! They're all sleazy. I'll just wait till they leave, then go get something to eat."

Physician #4:

Dr. Whine: "Okay, so what is this?"

Mike: "I carry Limpeter, an FDA approved treatment for Neuropriapism, and this is Dr. Grumpy. He's a neurologist out on the west side.."

Dr. Whine: "I used to not treat Neuropriapism. But now I do."

Mike: "Well, several studies have shown the efficacy of Limpeter for..."

Dr. Whine: "Mr. Grumpy, do you treat this?"

Dr. Grumpy: "Yes, I..."

Dr. Whine: "I'm sorry, did you say you're a PA?"

Dr. Grumpy: "No, I'm a doctor, a neurologist, and I use Limpeter in my practice for..."

Dr. Whine: "You know, Dr. Newmom, who works here, sort of, treats a lot of Neuropriapism patients. But she took a month off to have a baby, which is pretty damn unreasonable of her if you ask me, and so all her fucking Neuropriapism patients are seeing me now, so I could use this."

Dr. Grumpy: "Well, in several studies..."

Dr. Whine: "Don't you think that's ridiculous to take a whole month off to have a kid? I mean, it's not like she was in labor for the whole damn time, or had a C-section. I could see a 3-day weekend, but not a whole month."

Mike: "I..."

Dr. Whine: "Do either of you guys know anything about computerized chart systems? Our practice just switched to FubarMED, and I can't get it to work."

Dr. Grumpy: "No, I use..."

Dr. Whine: "Thank you for lunch." (grabs sandwich, walks out)

Physician #5:

Dr. Magnon was a guy who kept sticking his head in the breakroom. He'd yell "I'll be back in a minute! I have a question for you guys!" Then disappear, stick his head back in 5 minutes later and yell the same thing, and did this repeatedly. Mike hadn't gotten to talk to Dr. Magnon before, so we waited for him.

Finally, after 40 minutes, Dr. Magnon runs in.

Mike: "Hi, Dr. Magnon, I'm here with Dr. Grumpy and..."

Dr. Magnon: "Hey, do you guys know where the nearest gas station is?"

Mike: (whips out iPhone) "Sure, hang on... here it is, 1 block south and right around the corner."

Dr. Magnon: "Thank you." (grabs a sandwich, runs out. Through the window Mike and I watch him walk to his car and drive off).

When I got back to my office I told Dr. Pissy that I had no idea how benign he and I were until today.

I was flipping through some records from a patient who was worked up last year at Mayo, and came across a form with this heading:

(click to enlarge)

See, this is why I'm not good enough to work at Mayo. I just assume that my patients know how to discharge things from their gastrointentestinal system (one way or another). But at Mayo, they go above and beyond to give you a form that tells you.

(I'm being silly, obviously. The form had instructions on what to do after a colonoscopy. But I thought the heading could have been worded better)

I was surprised at the number of opinions, from both sides of the political aisle, that came out yesterday over my Medicare post. Many of you posted, others wrote to me privately.

I appreciate the majority of you who were able to keep it polite, and offer well-written comparisons of different systems, with the pros and cons of both. The input from those who have personally experienced both sides was especially helpful.

It's obvious that all feel something needs to be fixed, and I suspect the majority of "real people" out there would collectively find an answer, rather than just yelling about it.

Statistically, the political views of most Americans are purple, to varying degrees. Unfortunately, once elected it's more important to immediately become either fiery-red or bright blue, and those of us in the middle are forgotten. And that, to some extent, is why shit never gets done. It's easier to yell, scream, and argue over pithy things than to work together to fix the big ones. And a few screaming voices on either side are allowed to drown out a reasonable majority.

In closing, let me post a few addresses. Write your own emails. Feel free to send a link to my "Dear Medicare patients" post if you wish.

Maybe I'm just optimistic. But I'd like to think the health care issues we face can be solved in a way that benefits most, if not all of us. And in a civil manner, too.

Wednesday, February 17, 2010

Okay, I like the 12 ounce size. It lasts me at least 10-60 minutes (depending on how thirsty/ caffeine-deprived I am). It fits nicely in my hand and (when first opened) has a decent heft to it. Makes a good, "click-hiss" when you open up.

For years you've also offered the 8 ounce size, which several local hospitals stock. Not as tall, or as much, but same diameter so still fits nicely in my hand and has a nice "click-hiss"when you pop it. 3 of these equals 2 big ones.

BUT NOW YOU'VE GONE TOO FAR. The new pissy little "tall and thin" 7.5 ounce (how much money does that 0.5 ounce difference really save, for cryin' out loud?) is a disgrace. Look at it! It looks like a little silver can of fucking V8 juice!

This is SO not acceptable. It makes this high pitched "click" when you open. The can is so small and dainty I feel like I should drink it in little sips, pinched delicately between my thumb and index finger, with the pinkie sticking out, like I'm at one of my daughter's freakin' doll tea parties.

After February 28, 2010, I (and A LOT of other doctors) will be unable to see you.

This isn't your fault, but on that day Medicare will be cutting doctor reimbursements by 21%. Superimposed on the 15%-20% cuts already made at the start of the year, this will bring the reimbursement rate for your care to where it's LESS than my overhead for the time needed to see you. So I won't be taking any new Medicare patients.

You may be wondering how this happened, but don't go blaming this administration, or even the previous one, or congress, or the guys who write medical coding books, or the cycles of the moon, or whatever. Annual cuts have been programmed into Medicare for a long time (Medicare uses a formula that gradually reduces doctor reimbursements over time, ignoring the obvious fact that overhead costs will increase due to inflation) and the government (both parties) kept finding ways to do creative financing to work around them. After all, it's easier to put a band-aid on it then to actually fix the underlying problem. The problem with creative financing is that it's a house of cards, and sooner or later it falls apart.

And right now BOTH sides aren't doing a fucking thing to try and prevent these cuts from happening. Oh, sure, they pay some lip service and form committees, but lets face it: It's so much easier to argue over REAL issues, like gay marriage, school prayer, who's fornicating with who, if a guy on the other side is wearing unpatriotic cuff links, and whose fault everything is, than to actually try and solve minor problems like trying to keep the health care system afloat in the long run.

This isn't about the government. It's about your insurance. If any insurance company cuts its payment rates below what my overhead costs, I drop that insurance. Medicare is just another insurance, regardless of who's running it. I know this may surprise you, but I have to pay office rent, and staff salaries, and my own mortgage, and all kinds of other things. If I'm not making money, then I can't stay in business to help you. I didn't get into this job to get rich, but I do have to support my family.

So when you can't get in to see a doctor next month, I'm sure you'll find yourself saying "Well, I can't find anyone to treat my Parkinson's disease, but it doesn't matter because I know it was SO much more important that my legislators spent their valuable time arguing for/against gay marriage than trying to maintain jobs and health care."

I'm sure some of you will be angry at me, but look at it this way: If you ran Local Grocery, and had to pay $3 per tomato from a farmer, and the best price you could sell them at was $1, you'd either stop selling tomatoes or find another farmer.

Some of you may elect to pay cash to stay with me, and I'll be flattered.

Some of you will be pissed off (after all, it's just totally unreasonable of me to want to support my family), but I'm sure you'll find another neurologist. Some sucker who thinks he can make a fortune by collecting Medicare patients: all he has to do is make it up in volume. So he'll see 4 new patients in an hour OR 12 follow-ups in an hour. And you'll wait 3 hours in his lobby reading a 1987 issue of People magazine, and when you do get in to see him he'll give you exactly 5 minutes of his time to listen to your story, examine you, and decide what he's going to do. And don't expect him to have time to answer your questions.

You're in the ER with your grandmother and the rest of the family. The neurologist, while hacking & sneezing, has informed you that Grandma has suffered a massive bleed into the brain, and is going to die. You cope with this by:

A. Crying, and holding your grandfather.

B. Silently hugging your parents and kids.

C. Offer the neurologist some Sudafed and a Kleenex.

D. Looking up at the ceiling and yelling, "WHY?" repeatedly.

E. Complain loudly that you've noticed the wall sink in the ER room (which you're being moved out of, anyway) is broken, and demand to talk to a maintenance supervisor immediately.

If you answered E, it was a blast meeting you this morning. As you requested, a plumber and a neurosurgeon have been called, in that order. I think we can fix the sink.

Dr. Grumpy: "They told me you had a seizure last night. What do you remember?"

Mrs. Ictal: "I remember that bitch nurse waking me up. She kept asking me if I was okay. Of course I'm not okay. I'm in a fucking hospital, and seizure or not it was the first decent sleep I've had since I got here, and she had to ruin it."

Friday, February 12, 2010

Thank you for faxing me Mr. Crunch's hospital records from his overnight stay there last week.

You can stop now. I swear. We faxed the release 5 hours ago. So far we've received back 22 faxed copies of MY OWN RELEASE (it was a fax, I promise we have the original) from you and 18 copies of his 14 page hospital records. At this rate I'm going to have to send Mary to Costco for more paper.

I'm sure getting a release from a real gosh-durn big city doctor-o-medicine was the most exciting thing to happen at your hospital since a paint truck overturned there in 1999, but you should try to curb your enthusiasm. I have all that I need now, and you can stop.

Mrs. Geography: "We're taking a cruise out of New York. We fly to Niagara Falls, and board the ship. From there it goes up to Alaska, and we spend a few days there, and after a week we're back in New York. I'm looking forward to it, because I've never been to Alaska before."

Dude, it was so nice of you to drive your Mom to the appointment today. Her seizures are getting better, but she still can't drive. So it's good that she has a devoted 16 year old son like yourself to help. I'm sure you had better things to do with your brand-new driver's license (hell, I was 16 once, too), so I think you're a good kid for doing this.

I don't blame you for hanging out in the lobby during Mom's visit. That's the new 2010 Sports Illustrated Swimsuit Issue out there, and I know it's a hell of a lot more interesting than sitting back here listening to your Mom and I talk about her medications and side effects.

But, ya know, pretty much ALL the office staff, and likely some of the other lobby patients, noticed that you took the issue into the bathroom with you for a few minutes.

You can keep it. I'm serious. Dr. Pissy and I really don't want it back now. Consider it your reward for bringing Mom here today.

I don't mind being the bearer of bad news. I don't like it, but hey, it's part of the job.

But it really chaps me when a patient shows up "because Dr. Doofus said you'd tell me what the MRI showed". Most of the time Dr. Doofus hasn't even had the common courtesy to send me a copy of the damn report.

And in almost every case the studies are NORMAL. That's all. Or have some minor, benign variant like a harmless cyst. And so, because of human nature, the patients assume the worst. After all, Dr. Doofus is stonewalling them, and sends them to a specialist, so it must be time to draw up a bucket list.

Or they have a minor, benign, variant, and Dr. Doofus tells them it's either something horrible (because he has no idea what it is) or that it's sole the cause of ALL their symptoms, and Dr. Grumpy will know how to fix it. When in reality it's as relevant to their headaches (or whatever) as a hangnail would be.

I don't understand a lot of stuff in my own field, let alone outside of it. I don't expect other doctors to be any different. But if you don't know what it is or means, just be honest and say "I don't know!"

And DON'T tell them that they have to see me to get the results, then refuse to give them. They spend sleepless nights worrying about them. And when they invariably find out the test was normal, they get really pissed off at you. I've seen patients change doctors over that. And I don't blame them.

Wednesday, February 10, 2010

Mr. Spiz: "Well, I asked Dr. Dipchit about you, but he told me not to, because he thought you were incompetent and stupid. But I personally thought Dr. Dipchit was an idiot, and didn't know what he was doing, so I figured he wouldn't know a good neurologist if one bit him on the ass. So since he didn't recommend you, I decided that was a good reason to come here."

Tuesday, February 9, 2010

Kids, when you come to my office with your friends, it is extremely important that you remember which of you had what complaint.

I know that when you come to me during recess (usually the one before your math test), you do not have a note from the teacher telling me what your symptoms are. Generally, if something were hurting you, I'd assume you'd remember what it was. But, silly me, this isn't always the case.

By way of example, 2 of you demonstrated today how it should NOT be done. Faker and her bff Fakess came by today, with Faker complaining of sand in her eye and Fakess complaining that her hand was hurting.

Skool Nerse: "Which hand is it?"

Fakess: "The one I write with."

Skool Nerse: "And that is...?"

Fakess: "Um, did my Mom put it on that card she filled out?"

Skool Nerse: "No."

Fakess: "Okay it's, um, uh, ah, this one?"

Skool Nerse: "That's the hand that hurts? Is that the one you write with?"

Fakess: "Let me think..."

Skool Nerse: "You do that." (turns to Faker) "What's wrong with you?"

Faker: "I have sand in my eye."

Skool Nerse: "Which eye?"

Faker: "This one."

Skool Nerse: (carefully examines eyeball) "Hmm... I don't see any sand, or redness..."

Fakess: "Oh, that's because I'm the one with sand in my eye".

Faker: "Yeah, I forgot. It was her. I hurt my hand, this one."

As you can see, this duo made a number of mistakes that might have been avoided with a little practice beforehand. Therefore, kids, when trying to lie your way out of math tests, please remember that consistency in doing so is the key.

Look, dude, I'm sorry your team lost the Superbowl. I'm not a big sports fan, but I used to be, and so I understand you taking the loss personally.

I also understand having a few drinks to calm down. But being so upset that you missed 2 doses of your epilepsy pills wasn't a good idea (granted, you'd probably have gotten trashed and missed your meds even if the Colts had won, you'd just be happier about it).

No, the state MVD does NOT have an exception to allow you to keep driving in spite of stupid behavior. So you're done driving for a bit.

I AM serious! See? Here's the form, let's look at the exception boxes:

1. Seizures only occur during sleep (not you).

2. Patient has a warning that allows him to take protective action (not you either).

Nope, there isn't a box that says "Patient got shitfaced on cheap beer following his team's Superbowl loss, forgot to take his pills for 2 consecutive doses or go to work on Monday, and had a seizure while arguing with his girlfriend (who happens to be a New Orleans fan but was still nice enough to drive him to his appointment today)".

I ordered the enchilada platter, and perky waitress says "That's a good choice. My dad over there just ordered it, too."

Whatever. Our dinner goes on. A few minutes later I hear a lady across the aisle order a taco salad, and Ms. Perky says "That's a good choice. My dad over there just ordered it, too."

And a few minutes later a new group was seated in the booth behind us. A guy ordered the Grande Chimichanga, and Ms. Perky, of course, says "That's a good choice. My dad over there just ordered it, too."

Now, granted I wasn't really watching where she was pointing with "over there", but I can only come up with 3 options:

1. She's full of shit.

2. Her Dad has ahuge appetite.

3. Her mother was remarkably promiscuous, and by an amazing coincidence all of this girl's potential dads felt like Mexican food last night.

Don McLean, in one of the greatest songs ever written, summarized the tragedy, and in a truly remarkable collection of words told the story of American music from the 1950's to 1969.

A long, long time ago...I can still rememberHow that music used to make me smile.And I knew if I had my chanceThat I could make those people danceAnd maybe they'd be happy for a while.

But February made me shiverWith every paper I'd deliver.Bad news on the doorstep;I couldn't take one more step.

I can't remember if I criedWhen I read about his widowed bride,But something touched me deep insideThe day the music died.

So bye-bye, Miss American Pie.Drove my Chevy to the levee,But the levee was dry.And good old boys were drinking whiskey and ryeSinging, "this'll be the day that I die."This'll be the day that I die."

Did you write the Book of Love?And do you have faith in God above,If the Bible tells you so?And do you believe in rock and roll,Can music save your mortal soul,And can you teach me how to dance real slow?

Well, I know that you're in love with him`Cause I saw you dancin' in the gym.You both kicked off your shoes.Man, I dig those rhythm and blues.

I was a lonely teenage broncin' buckWith a pink carnation and a pickup truck,But I knew I was out of luckThe day the music died.

I started singin',Bye-bye, Miss American Pie.Drove my Chevy to the levee,But the levee was dry.And good old boys were drinkin' whiskey and ryeSingin', "this'll be the day that I die.This'll be the day that I die"

Now for ten years we've been on our ownAnd moss grows fat on a rolling stone,But that's not how it used to be.When the Jester sang for the King and Queen,In a coat he borrowed from James DeanIn a voice that came from you and me,

Oh, and while the King was looking down,The Jester stole his thorny crown.The courtroom was adjourned;No verdict was returned.And while Lennon read a book on Marx,The Quartet practiced in the park,And we sang dirges in the darkThe day the music died.

We were singing,Bye-bye, Miss American Pie.Drove my chevy to the levee,But the levee was dry.And good old boys were drinkin' whiskey and ryeSingin', "this'll be the day that I die.This'll be the day that I die."

Helter Skelter in a summer swelter.The Byrds flew off with a fallout shelter,Eight miles high and falling fast.It landed foul on the grass.The players tried for a forward pass,With the Jester on the sidelines in a cast.

Now the half-time air was sweet perfumeWhile the Sergeants played a marching tune.We all got up to dance,Oh, but we never got the chance!`cause the players tried to take the field;The marching band refused to yield.Do you recall what was revealedThe day the music died?

We started singing,"bye-bye, Miss American Pie."Drove my Chevy to the levee,But the levee was dry.And good old boys were drinkin' whiskey and ryeSingin', "this'll be the day that I die."This'll be the day that I die."

Oh, and there we were all in one place,A generation lost in spaceWith no time left to start again.So come on: jack be nimble, jack be quick!Jack Flash sat on a candlestick'Cause fire is the devil's only friend.

Oh, and as I watched him on the stageMy hands were clenched in fists of rage.No angel born in hellCould break that Satan's spell.

And as the flames climbed high into the nightTo light the sacrificial rite,I saw Satan laughing with delightThe day the music died

He was singing,"Bye-bye, Miss American Pie."Drove my Chevy to the levee,But the levee was dry.And good old boys were drinkin' whiskey and ryeSingin', "this'll be the day that I die."This'll be the day that I die."

I met a girl who sang the bluesAnd I asked her for some happy news,But she just smiled and turned away.I went down to the sacred storeWhere I'd heard the music years before,But the man there said the music wouldn't play.

And in the streets the children screamed,The lovers cried, and the poets dreamed.But not a word was spoken;The church bells all were broken.And the three men I admire most:The father, son, and the holy ghost,They caught the last train for the coastThe day the music died.

And they were singing,"Bye-bye, Miss American pie."Drove my Chevy to the levee,But the levee was dry.And good old boys were drinkin' whiskey and ryeSingin', "this'll be the day that I die."this'll be the day that I die."

They were singing,"bye-bye, Miss American Pie."Drove my Chevy to the levee,But the levee was dry.And good old boys were drinkin' whiskey and ryeSingin', "this'll be the day that I die."

Mr. Smash: "Well, this lady in front of me had this huge rack. I think she used it for towing stuff. And I guess something broke, and her rack flew off and smashed my front end. It was one of the biggest racks I've ever seen. I mean, it must have hit 2 or 3 other cars too before it stopped, and people were swerving, and everyone was watching her rack lying in the middle of the road. And she didn't care if she'd hurt anyone else. All she kept saying was that we'd ruined her rack, and that she'd paid a lot of money for it, too."

A 60-year-old man with acute pancreatitis developed persistent hiccups after insertion of a nasogastric tube. Removal of the latter did not terminate the hiccups which had also been treated with different drugs, and several manoeuvres were attempted, but with no success. Digital rectal massage was then performed resulting in abrupt cessation of the hiccups. Recurrence of the hiccups occurred several hours later, and again, they were terminated immediately with digital rectal massage. No other recurrences were observed. This is the second reported case associating cessation of intractable hiccups with digital rectal massage. We suggest that this manoeuvre should be considered in cases of intractable hiccups before proceeding with pharmacological agents.

In light of my many posts on obvious and/or stupid research, quite a few of you have written in with that question.

There are several answers, but the most common one is busy work. And I am my own best example.

I am not an academic/research person. I have nothing against those who are, it's just not my thing. One of my career goals was to die unpublished. I didn't ever want my name in any journal, anywhere.

But when I was doing my fellowship, the chairman was of the opinion that it was critically important that everyone get published at some point, regardless of the quality of the research involved. So he came up with an absolutely bullshit project for me. And I was faced with the options of doing it or failing the fellowship.

So I did the project. It was remarkably stupid and pointless. it consisted of me reading through MOUNTAINS of old charts, going back several years, and making notes. For the record, a lot of BS research is done this way. Some poor sucker in training is forced to tediously analyze endless piles of old charts or videos or patient forms or something, to come up with worthless information, under the threat of failing out of their program.

Let's face it. You can get pointless data out of anything: "Our chart review found that people who saw the original release of The Wizard of Oz in 1939 were more likely to have Alzheimer's disease in 2009 then those who'd seen the original release of Star Wars in 1977. This suggests an unidentified risk factor for dementia in seeing MGM films vs. those made by 20th Century Fox."

And these studies are generally cheap to do, because you're already paying the salary of the resident or fellow involved (even cheaper for med students, since they work for brownie points).

And there's always a crappy journal out there, trying to get advertising dollars and willing to publish anything to get readers.

So I found some meaningless data, and at a weekly division meeting I presented it. There were 4 attending physicians and 2 fellows in my subspecialty at the time. 3 of the attendings, and both of the fellows (including me) agreed the paper and it's findings were meaningless drivel.

Unfortunately, the only person who disagreed was the chairman. And since he was editor at the time of some desperate medical journal, he got my paper published there.

To make matters worse, he then got me a poster spot at the annual neurology meeting that year. So I had to go to this meeting, set up a poster with my worthless data on it and then STAND BY IT wearing a badge that identified me as the author.

So for the required 2 hours I stood there, trying to smile at all the big league academics going by. Most looked at my poster and politely didn't say a word. A few gave me sympathetic looks. 3 made comments about how worthless it was (I silently agreed). Only one said something kind.

I left the poster hanging in the meeting hall. I think I was the only person who didn't take theirs home. I assume it's in a landfill by now.

My shitty article got published a few months later, and several intelligent neurologists (who I assume were reading in a hot tub) found my paper to be such absolute garbage that they felt the need to write to the journal to complain. And the journal editor, my chairman, forwarded the letters to me to write a rebuttal.

How do you defend the indefensible? Hell, I agreed with them.

But by this point I'd completed the fellowship, and was an attending physician. And I didn't care. So I just tossed his requests in the trash.

So my sole contribution to the medical literature is out there. Fortunately, as the years go by, it will continually be buried under newer (though equally worthless) data.

And that's where at least some crappy research comes from. And I suspect most of it has similar origins. Some poor sap who's under pressure to publish something, anything, regardless of how stupid or obvious it is, or people trying to pad their resume, or someone with way too much time on their hands and absolutely no life (if you're in the last category, get a dog. Or join Facebook. Or do ANYTHING to waste your time in a more useful way), and crappy journals willing to publish anything.

Welcome to my whining!

This blog is entirely for entertainment purposes. All posts about patients may be fictional, or be my experience, or were submitted by a reader, or any combination of the above. Factual statements may or may not be accurate.

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